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Diabetes and thrombolysis for acute stroke: a clear benefit for diabetics
Author(s) -
Reiter M.,
Teuschl Y.,
Matz K.,
Seyfang L.,
Brainin M.
Publication year - 2014
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12263
Subject(s) - medicine , thrombolysis , diabetes mellitus , stroke (engine) , cardiology , acute stroke , tissue plasminogen activator , endocrinology , myocardial infarction , mechanical engineering , engineering
Background and purpose Diabetes is a predictor for poor outcome after thrombolysis in stroke patients, and early post‐stroke glycaemia is associated with higher rates of post‐thrombolytic symptomatic intracerebral haemorrhages ( SICHs ). Diabetic stroke patients may nevertheless profit from thrombolysis. Here, we compared outcome data of matched thrombolysed and non‐thrombolysed diabetic and non‐diabetic stroke patients from a national database. Methods The outcomes of 1079 matched quadruples, each consisting of a thrombolysed diabetic, a non‐thrombolysed diabetic, a thrombolysed non‐diabetic and a non‐thrombolysed non‐diabetic case (a total of 4316 cases), enrolled in the A ustrian S troke U nit R egistry (2004–2013), were compared. Patients were matched according to sex, age, stroke severity, pre‐stroke disability and prior stroke. Results A regression model with improvement as depending variable found no effect of diabetes ( P = 0.158) or the interaction diabetes × thrombolysis ( P = 0.507), whereas the effect of thrombolysis itself was highly significant ( P < 0.001). Functional outcome (modified R ankin S cale) was significantly better in thrombolysed than in non‐thrombolysed diabetic patients at discharge from the stroke‐unit ( P < 0.001) and 3 months later ( P = 0.006). No significant differences were found in the number of SICHs after thrombolytic treatment between diabetic (4.9%) and non‐diabetic strokes (3.5%). Both groups had a higher risk of SICH compared with the non‐thrombolysed groups (diabetics 2.6%, non‐diabetics 2.5%). Due to lack of documentation, the effect of admission blood glucose on SICH was not investigated. Conclusions Data from this nationwide survey show that diabetic stroke patients receive a substantial benefit from thrombolysis, and therefore diabetic strokes should not be excluded from thrombolytic treatment.